November 6th, 2017

The President And His Opioid Commission: Out Of Synch

56! That is the number of recommendations made in the final report of the President’s Commission on Combating Drug Addiction and the Opioid Crisis. The single largest group – 21 –  relate to the treatment of opioid addiction. Law enforcement is the focus of an additional 7. Governor Christie and his team are to be commended for the comprehensiveness of the 131-page report and especially on its emphasis on treatment.

The bad news is that there is little evidence that this work will translate into significant change. In my article last week, I noted how disappointing was the event in which the President declared a public health emergency in regard to the opioid problem. In contrast to the Commission report, he made only passing references to treatment and spent more time focusing on law enforcement. He also expressed confidence in the effectiveness of “a massive advertising campaign to get people, especially children, not to want to take drugs in the first place,” despite little evidence of the effectiveness of this type of intervention in the past.

Rather than schedule the public emergency declaration event to coincide with and publicize the release of the Commission report, it was held six days earlier. When the report was actually released, the only response was a 115-word White House press release, concluding with, “We are grateful for the Commission’s extensive work since March, and look forward to reviewing these recommendations as the entire Administration continues to work to lessen drug demand and the opioid crisis.” Moreover, with the Commission due to dissolve shortly and key leaders at HHS, ONDCP, and DEA missing, how many of these recommendations will be implemented is unclear.

A final telling indicator can be found by reading the list on the White House website of what the administration considers to be the top eight issues in the country. The opioid problem is not among them.

Fortunately, there is good news from another agency of the Federal government – the FDA. First, Commissioner Scott Gottleib testified before Congress on October 25th in support of using medications such as buprenorphine in the treatment of opioid addiction, including for an extended period of time: “Clinical evidence shows that people may need treatment with medications for long periods of time to achieve a sustained recovery. Some may even need a lifetime of treatment. Recognizing this, the FDA is revising the labels of these medical products to reflect this fact.”

Secondly, an FDA advisory panel recommended the approval of an injectable form of depot buprenorphine. This formulation would increase treatment adherence and reduce medication diversion while being easier to use than an already approved implantable buprenorphine. The FDA has until the end of November to respond to this recommendation and I will let you know in this space as soon as they decide.

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